Open Enrollment for Covered California starts 11/1/17 and ends 1/31/2018. https://www.coveredca.com/apply/ Despite Republican efforts to repeal and replace, they have not succeeded. Despite President Trump’s efforts to sabotage ObamaCare (the Affordable Care Act), California has developed workarounds to continue California’s remarkable progress in covered our state’s uninsured.

Code Talk is an innovative job-training program for homeless and low-income women. http://www.stjosephctr.org/codetalk/ It is run by the St Joseph’s Center in Venice, CA.

California’s public school performance ranks 42nd in the nation. https://www.edweek.org/media/ew/qc/2015/shr/16shr.ca.h34.pdf Before Prop 13, we ranked 7th. We have got to start fixing the state’s poor performance right now. Our children and our state’s futures are at stake if we fail to act.

In thinking about the United States response to Hurricane Maria’s devastation of Puerto Rico and the US Virgin Islands, I began to wonder why they cannot vote in Presidential elections, and why their representatives cannot vote in the House of Representatives or the Senate. These policies appear to be vestiges of our short imperial quest to acquire colonies during the late 19th and early 20th century, keeping up with the Europeans.

The Romans built great roads and bridges to transport commerce and armies, and great aqueducts and arches to transport water and baths and sewers for hygiene; they were so well built that they remain today throughout Europe. This is/was the eternal city. What will be the American legacy in 2000 years?

The non-partisan Tax Policy Center reports that the Republican tax plan will increase the federal deficit by $2.4 billion over the next ten years and then another $3.2 billion over the following decade. Over the first decade, it would reduce business taxes by $2.6 trillion, eliminate estate and gift taxes for the extremely wealthy by $240 billion and increase individual income taxes by $470 billion.

President Trump is doing what he can to sabotage the federal and state Exchanges and the individual health insurance market. Here is the context, what he has been doing, the countermeasures some states are taking, and the need for and prospects of Affordable Care Act fixes.

Senate Republicans are planning to vote next week on a Budget Resolution for 2018. It includes $500 billion in cuts to Medicare and $1 trillion in budget reductions to Medicaid. Their goal is to finance $1.5 trillion in tax cuts – the bulk of whose benefits go to the extremely wealthy, the top 1% of Americans receive 80% of the benefits of the tax cuts.

Recently I joined the Board of Directors of Vision y Compromiso – a training and advocacy network for more than 6,000 promotoras and community health workers, led by a great friend and wonderful leader, Maria Lemus. http://visionycompromiso.org/

In the United States public and private financing of the nation’s health care are split 50/50. In California in 2015, a total of $292 billion was spent on personal health care services. Of that total, $104 billion was spent on private insurance), $62 billion on Medicaid, $64 billion on Medicare and $61 billion comprised all other health spending (including a range of expenditures from the Veterans Administration, Prisons, personal out of pocket, Workers Compensation and Auto insurance). In California, we have a smaller percentage of residents with private coverage and a higher share with public coverage than most states in the Midwest and Northeast.

California has made great progress implementing the Affordable Care Act (ACA), with over 6 million people newly enrolled in either Medi-Cal or Covered California since December 2013. The ACA offers major opportunities for states to meet these goals with a §1332 waiver using different approaches. There may be bi-partisan interest in reviving and revising §1332 waivers in the wake of the failure of the Graham Kennedy bill to secure the votes needed to repeal the ACA.

They have saved the worst for last or next to last or maybe a never-ending nightmare of repeal efforts (Groundhog Day). The salient points of Graham Cassidy are: a shift and reduction of the ACA’s financial resources from the federal government to the states as a time limited block grant; a shift of federal resources from the leader states to the most resistant Southern states that have done little or nothing beyond obstruction; waivers to allow states to disenfranchise and/or insurers to charge higher premiums to those with pre-existing conditions and a per capita cap on the federal match for the Medicaid program. For California, these proposals could not be more damaging. A recent report from the CDC (Centers for Disease Control) found that the uninsured rate in California had fallen from 17% to 7% due to the state’s successful implementation of the ACA. This bill will erase all that progress and do far more extensive damage to states' budget and health care system. Over 30 million Americans would lose their coverage.

I lived in Charlottesville twice. The first time was shortly after my birth; my father was attending University of Virginia Law School and rehabbing from his war injuries incurred after his jeep went over a German land mine in France. Hard to believe, but I have lifetime friends from both my first stay and my second stay in Charlottesville.

We dodged a bullet in the Senate; there is now a moment and opportunity for constructive bipartisan problem solving, so let’s start improving the Affordable Care Act. Here are a few ideas worth considering on how to dramatically improve affordability of coverage and accessibility of care in the Exchanges under the Affordable Care Act (ACA).

This is not about statues, but about the frightening resurrection of white supremacy movements that many had thought were obsolete and yesterday’s news. So let’s first discuss the issues, then let’s discuss the symbols.

President Trump is considering ending federal ACA funding for cost sharing reductions. This ACA funding allows individuals with incomes up to 250% of the federal poverty level to reduce their copays and deductibles in the individual market. It costs about $7 billion annually and helps about 5.7 million Americans. He believes that if the funding was ended, the Health Insurance Exchanges would collapse and Democrats would agree to repeal and replace the Affordable Care Act.

Within this bi-partisan House caucus, there are several points of burgeoning agreement on the future of the Affordable Care Act (ACA): 1) Extend cost sharing reductions. 2) Fund states to reduce individual market premiums through reinsurance or high-risk pools. 3) Eliminate the medical devices tax. 4) Roll back the employer mandate to employers of 500 or more employees. 5) Value and outcome based Medicare reimbursements. 6) Cross state sale of insurance.

The House and Senate need to convene the problem solvers as opposed to the Freedom Caucus bomb throwers and work out the following issues: 1) cost sharing reductions, 2) reinsurance and risk adjustments, 3) care and coverage in rural regions, 4) incentives for cost effective care and 5) the uninsured in the non-expansion states.

Straight repeal has failed; repeal and replace has failed. Senate Republicans now will try to pass skinny repeal. Skinny repeal would at a minimum repeal the individual responsibility, the employer responsibility and the medical devices tax.